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Criteria for undernutrition screening in hospitalised infants under 6 months: a diagnostic accuracy study in a
Ifeyinwa Obiageli Ezeofor1, Ada Lizbeth Garcia2, Charlotte Margaret Wright1
1Child Health, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
Insights
Undernutrition is prevalent in hospitalized infants under 6 months in Nigeria. A low weight-for-age Z-score (WAZ) is a valuable screening tool, with combined WAZ and mid-upper arm circumference (MUAC) offering higher accuracy.
Area of Science:
- Pediatric Nutrition
- Global Health
- Diagnostic Accuracy Studies
Background:
- Undernutrition poses a significant threat to infant health, particularly in resource-limited settings.
- Early detection of undernutrition in hospitalized infants is crucial for timely intervention and improved outcomes.
- Simple anthropometric measures are often used to assess nutritional status in infants.
Purpose of the Study:
- To determine the prevalence of undernutrition among hospitalized infants under six months of age in Nigeria.
- To evaluate the effectiveness of simple index measures, such as weight-for-age Z-scores (WAZ) and mid-upper arm circumference (MUAC), in detecting undernutrition.
- To compare the diagnostic accuracy of different anthropometric indicators for undernutrition in this population.
Main Methods:
- A diagnostic accuracy study was conducted involving 125 hospitalized infants aged 2 weeks to 6 months in Enugu, Nigeria.
- Measurements included weight, length, mid-upper arm circumference (MUAC), and skinfolds.
- Undernutrition was defined by low weight-for-age Z-scores (WAZ), low weight-for-length Z-scores (WLZ), low MUAC (<11 cm), weight faltering, or low sum of skinfolds (SSF <10 mm).
Main Results:
- The overall prevalence of undernutrition was 36%, with 33% having low sum of skinfolds (SSF) and 24% exhibiting weight faltering.
- Low weight-for-age Z-scores (WAZ) demonstrated high diagnostic accuracy (sensitivity 69%, PPV 86%, AUC 0.90), followed by MUAC (sensitivity 73%, PPV 73%, AUC 0.86).
- Combining low WAZ and MUAC further improved detection (sensitivity 90%, PPV 82%). Weight-for-length Z-scores (WLZ) showed the least utility.
Conclusions:
- Hospitalized infants under six months in Nigeria exhibit a high prevalence of undernutrition.
- Low WAZ is an effective screening criterion for undernutrition in this high-risk population.
- Combining WAZ with MUAC measurements provides enhanced discrimination for identifying undernourished infants, while WLZ is less useful.
Purpose:
We aimed to describe the prevalence of undernutrition in hospitalised infants aged under 6 months and test the utility of simple index measures to detect undernutrition.
Design:
Diagnostic accuracy study: weight, length, mid-upper arm circumference (MUAC), triceps and subscapular skinfolds were measured in infants aged 2 weeks to 6 months admitted to a Teaching Hospital in Enugu, Nigeria. : low (<-2SD) weight-for-age Z-scores (WAZ), weight-for-length Z-scores (WLZ); MUAC <11 cm. weight faltering (conditional weight gain below fifth percentile for healthy Nigerian infants) or sum of skinfolds (SSF) <10 mm.
Results:
Of 125 hospitalised infants, only 5% (6) were admitted specifically for undernutrition, but low SSF were found in 33% (41) and, 24% (25) with known birth weight had weight faltering, giving an undernutrition prevalence of 36%. Low WAZ was the most discriminating predictor of undernutrition (sensitivity 69%, positive predictive value 86%, likelihood ratio 5.5; area under receiver operator curves 0.90) followed by MUAC (73%, 73%, 4.9; 0.86), while WLZ performed least well (49%, 67%, 2.9; 0.84). Where both MUAC and WAZ were low, there was sensitivity 90%, positive predictive value 82% and likelihood ratio 8.7.
Conclusions:
Infants aged under 6 months admitted to hospital in Nigeria had a high prevalence of undernutrition. In young, high-risk population, a low WAZ alone was a valuable screening criterion, while combining weight with MUAC gave even higher discrimination. Measurement of length to calculate WLZ was a less useful predictor in this population.
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